336426511-1-29-2025-56-AS-EMAN-DE4MXH-20250221085957

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426511
Report Date: 01/29/2025
Date Signed: 01/29/2025 12:39:51 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/15/2024 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20241015142228

FACILITY NAME:	AVISTA SENIOR LIVING MAGNOLIA		FACILITY NUMBER:	336426511
ADMINISTRATOR:	BLASIA LEE-LOLE		FACILITY TYPE:	740
ADDRESS:	737 MAGNOLIA AVE		TELEPHONE:	(951) 737-1600
CITY:	CORONA	STATE: CA	ZIP CODE:	92879
CAPACITY:	180	CENSUS: 97	DATE:	01/29/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Executive Director Andrea Perez		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff are not ensuring safe keeping of resident's personal items

INVESTIGATION FINDINGS:

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On 01/29/2025 at 09:45 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility to deliver the findings of the above allegation. LPA Brown explained the purpose of the visit to a staff. Staff contacted Executive Director (ED) Andrea Perez and informed of the visit. ED Perez and Vice President of Operations Kristie Stark met with LPA Brown. The investigation consisted of file review, interviews with staff and residents as well as observation.

The investigation was conducted by LPA Brown. The investigation consisted of file review and interviews with relevant parties. The allegation indicates staff are not ensuring safe keeping of resident's personal items. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with six (6) of seven (7) residents indicated that staffs at the facility are making sure that their personal belongings are safe keep. Six (6) of seven (7) residents interviewed reported that there's no incident that happened at the facility that any of their personal belongings are missing. ***Continuation in LIC9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20241015142228

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: AVISTA SENIOR LIVING MAGNOLIA	FACILITY NUMBER: 336426511
	VISIT DATE: 01/29/2025

NARRATIVE

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Six (6) of seven (7) residents interviewed stated that they feel safe at the facility because staffs at the facility are ensuring that their personal belongings are safe keep in their room. Interview with Resident #1 (R1) indicated that R1's not sure if the missing items that R1 reported were really missing as it might just be in R1's room. LPA Brown unable to interview four (4) residents as two (2) residents refused, one (1) resident was not in the room and one (1) resident sleeping. Interview with 11 of 11 staffs indicated that they are making sure that the personal belongings of their residents are safe keep in their room by giving reminders to their residents to lock their valuable personal belongings in their room. In addition, seven (7) of seven (7) care staffs interviewed reported that when they are doing their rounds to check on their residents every two (2) hours, they are always checking that their residents’ room are locked. Moreover, 11 of 11 staffs interviewed revealed for the past year, R1 had multiple incidents of reporting missing items in R1's room and after a day or two (2) days, R1 will inform them that R1 found the reported missing items in R1's room. Furthermore, 9 of 9 staffs interviewed stated that R1 always make sure that R1's room was locked and there's no incident that happened at the facility that they did not ensure that R1's personal belongings are safe keep. Nine (9) of nine (9) staffs interviewed shared that there's always two (2) staffs that will go to R1's room if they need to assist R1 due to R1's history of accusing staff of stealing R1's personal belongings. During the facility visit on 10/18/2024, former ED Kellie Smith provided LPA Brown the facility's Theft and Loss policy. In addition, during the facility visit on 10/18/2024, 11/07/2024 and 12/09/2024, LPA Brown observed staffs at the facility ensuring that the residents rooms were locked while conducting their rounds to check on their residents. Also, LPA Brown observed R1's room locked.

Based on the evidence, the allegation that staff are not ensuring safe keeping of resident's personal items is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 was discussed and provided to ED Andrea Perez.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

LIC9099 (FAS) - (06/04)

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